But behind that rude outburst there’s genuine concern about whether illegal immigrants would benefit from whatever plan emerges from the House and Senate.

Ever since this debate began, Democrats have insisted that the undocumented would not be helped by health legislation. Republicans maintain that’s not true.

Before I get into an analysis of that argument, let me quickly explain something that Obama kind of slipped into his speech Wednesday without much fanfare: He said that everyone would be required to buy health insurance.

Supporters of Obama’s approach say that only with a mandate for individuals to buy insurance can those who are insured now get out from under footing the bill for emergency care for those who choose not to buy insurance. They say that the mandate would take effect only along with a requirement that insurance companies sell insurance to people regardless of any pre-existing condition and that they don’t drop people if they get sick. And there would be subsidies for those who can’t afford insurance.

Obama alluded to the fact Wednesday that those on both ends of the spectrum have their own views of reform. Those on the left say the only real reform is a single-payer system, something like Medicare for all. Those on the right say we should have everyone buy insurance on their own. While neither of these positions are going to win the day, the deal seems to be moving more in the direction of a market-based, personal responsibility-driven system than one with the kind of government control Republicans fear. We’ll see.

Now back to health care and immigration.

Here’s a look at what the bill says and a nonpartisan analysis of it. So far there’s only one bill that’s poised to be voted on by lawmakers. That’s HR 3200 in the House. While one Senate committee has approved a measure, the key Senate Finance Committee is still working on its version.

So all of what I’m going to explain is related to the House bill.

Bill bars illegal immigrants

First, Section 246 clearly states: “Nothing in this subtitle shall allow federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”

Seems pretty clear. If any subsidies are given to people who cannot afford health insurance they won’t be given to illegal immigrants.

Republicans on the House Ways and Means Committee, though, said that doesn’t go far enough. They wanted a requirement added that would make people prove citizenship in order to get these credits. Democrats said that would create an enforcement nightmare.

Sen. Kent Conrad, D-N.D., emerged from a closed-door meeting of Senate Finance Committee negotiators Friday morning and said they too will include a clause in their bill barring illegal immigrants from getting subsidies. And he suggested that the Senate might go further and somehow use Social Security numbers to check people’s eligibility for such credits.

Clearly, if the government had a good way to crack down on people who live here illegally we wouldn’t have an estimated 12 million undocumented immigrants living here.

But there are already rules written to prevent illegal immigrants from getting Medicaid, participating in the State Children’s Health Insurance Program or SCHIP and from getting on Medicare. And there has been no suggestion of widespread participation in those programs by illegal immigrants.

And that may be because those people here illegally are understandably afraid to come in contact with government period, lest they be found out and deported.

So illegal immigrants with limited means tend to get their health care either from community clinics or hospital emergency rooms. Those places don’t ask about someone’s citizenship when they ask for care.

Hospitals by law are not allowed to turn anyone away from an emergency room regardless of their ability to pay. That wouldn’t change under any of the reform proposals under discussion.

Back in 2003, Rep. Dana Rohrabacher attempted to require hospital administrators to notify federal officials when they treated someone they believed to be an undocumented immigrant.

In fact, Rohrabacher, R-Huntington Beach, traded a “yes” vote on the Medicare prescription drug bill for a promise by then Speaker Dennis Hastert that Rohrabacher would get a vote on his bill on the House floor. He got his vote in 2004 and his bill was defeated 88-331.

This is interesting: If a bill passes that requires virtually everyone to have insurance, by default, those who show up uninsured at emergency rooms in the future could well be assumed to be illegal immigrants.

That could, said one immigration advocate I talked with, lead to fewer undocumented people seeking emergency room care. They would probably continue to use local clinics and could well just forgo medical care. Whether that will serve as a deterrent to future illegal immigration is something to watch.

Undocumented could buy policies

Second, illegal immigrants would be eligible under the House bill to buy health policies through the insurance exchange that would be set up to promote more competition in the industry.

There doesn’t seem to be any dispute about that.

The reality is many illegal immigrants buy health insurance now, either because they work for a company that provides health insurance or they have gone on the open market and bought policies. Nothing in this bill would change that.

There is a bit of a Catch 22 in this bill for illegal immigrants.

The House bill would require that everyone have health insurance. If you can’t afford it the federal government would help and there are expected to be some hardship exemptions to the mandate. If you don’t comply, the IRS would penalize you on your taxes.

Under federal tax law, illegal immigrants who file taxes and meet certain residency requirement would fall under this mandate even though they wouldn’t be eligible for federal subsidies to help them get insurance.

Experts estimate that about half the illegal immigrants in the U.S. get a regular paycheck that is taxed.

So illegal immigrants subject to the mandate who don’t buy health insurance could apply for one of the hardship exemptions. But again, they may well be afraid that would raise a red flag and get them deported.

So if this all comes to pass, these illegal immigrants would either have to apply for the exemption and risk deportation or just pay the fine for being uninsured.

Family coverage unclear

One section in this bill remains murky when it comes to illegal immigrants.

Rep. Gary Miller, R-Diamond Bar, has posted on his Web site an extensive look at the bill with page references to back up his conclusions.

In his analysis, he says that on page 133 there’s a clause that “states that if one member of a family is afforded coverage all members would have coverage, thereby creating another loophole to give taxpayer-subsidized health care to illegal aliens.”

The nonpartisan Congressional Research Service, which provides reports to lawmakers analyzing legislation, isn’t so sure that Miller’s analysis is correct.

The provision he is referring to is in Section 242 and titled “Treatment of Family.” The legislative language is frankly confusing.

The CRS reading is that the bill “does not expressly address” what would happen in the case of a so-called mixed status family, where the wife, for example is a legal permanent resident, the husband an illegal immigrant and their child a U.S. citizen.

“It appears that the Health Choices Commissioner would be responsible for determining how the credits would be administered in the case of mixed-status families,” the report says. Translation: the government bureaucrats have to figure this one out.

The way this works is that once a bill like this is passed, government officials write regulations to administer it. And they do look closely at what the lawmakers meant when they passed the bill.

I suspect that given the spotlight that has been turned on the illegal immigration issue both during the town halls last month and as a result of Wilson’s outburst, it will be clear to those who implement any health reform law that Congress doesn’t want illegal immigrants to benefit from it.

Of course immigration advocates say all this talk about whether undocumented immigrants will benefit from this bill would be moot if Congress would pass a comprehensive immigration reform bill and those illegal immigrants living here now could earn legal status.

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